Monday, March 29, 2010

The Lottery

It's that time again. LOTTERY TIME!

Nation-wide, the lottery is exciting because there is a chance of winning a jackpot. Our medical school lottery does not promise such fortune. Instead, it's anxiety-provoking as we rank our preferences for our fourth year schedules. Once everyone ranks their preferences, a computer goes through and randomly assigns us our electives.

As I rank numerous selections, I am reminded of highschool precalculus, thinking about all the possible permutations. If only I knew game theory to maximize my chances of constructing a perfect fourth schedule.

In truth, it feels like being back in college. Having spent my whole life in public school, I am familiar with the process that comes with allocating scare resources to meet a high demand. In our cases, there are just way to many students coveting the same spots in certain sub-internships, fourth year electives.

Inevitably, we all have to compromise and realize we will never get the perfect schedules. Regardless of the lottery results, I hope my schedule has some resemblance to some of my 60 rankings.

Monday, March 22, 2010

The Small Things

Sometimes, it's the small things that make your day.

Today, I was moved when my patient gave me the gift of chocolate to celebrate the birth of her son. The choclate was wrapped in light blue foil, one was a square piece with a picture of baby boy and the other was cigar-shpaed piece. My first patient gift.

As I was walking be her room, her mother greeted with me a hug.

"Eisha, it is so good to see you. You need to come and see the baby." she said.

I walked into the room and was instantly greeted by the patient, who looked up at me with relief and joy.

"He is big. 9 lbs and 11 ounces. My pelvis was just not big enough for his big body. So, we had a C-section. It was not what I had expected, but he just was not coming. Oh well, it was worth it."

She smiled as she looked at her son with his chubby face and full lips. He looked just like his dad. He was sucking on his fingers and sleeping quietly.


Over the course of the three weeks I spent on labor and delivery, I got to know the patient and her family very well. This twenty-something year-old,, first time mother, had recently moved to SF from the South. She retained her southern accent and her mother maintained a certain amount of Southern hospitality. The patient always wore her straight black hair down. Her face was framed by thick-rimmed glasses. She was friendly and seemed to always be concerned.

She had become my longitudinal patient. She always came with her mother. I had seen them regularly in triage, where she came concerned about contractions that the she thought were the harbingers of labor. Each time she came in, we would connect the monitor and reassure her that she was not in labor.

She returned in the days leading up to her delivery due to concerns that she was not feeling her baby move. There were also some non-reassuring changes noted in her fetal heart strip. For some reason, when she showed up to triage, everything returned to normal.

"He makes a liar out of me," she would say, right before we let her go home.

On her last triage visit, she realized she was not in labor. She was close to her due date, so we decided to induce her labor. We all knew that if we discharged her, she would be back soon enough.


I gave her hug and made my way to the crib. I was finally getting to meet the baby we had been monitoring with ultrasounds, fetal heart monitoring, and cervical exams over the last three weeks. I had come to know his 2-d black and white ultrasound image, as well as the amniotic fluid levels that bathed him in his in-utero home. He had been a constant source of worry for his mom. Now, he had entered our world. And it was such a pleasure to see his face and his little hands.

Over three weeks, I felt like I had really become a part of my patient's life. In her room, I was surrounded by strangers, who had come to know me.

It these small things that make it all worth it.

Saturday, March 6, 2010

Great Catch

"Is this your first catch?" My patient asked.

"Yes." I responded sheepishly. Is it that obvious, I thought.

"Well, Great catch." She responded

"Cheers to you and cheers to the baby." Her husband said.

Five days ago at 1:19 AM, I delivered my first baby. The baby boy, weighing 8 lbs and 4 oz came into the world crying loudly after his mother labored for nearly a full day. I held him in my arms and watched as he opened his eyes to see the world he had just entered.

I remember the first time I went to the labor and delivery floor. It was within my first weeks of medical school. I made my way up to the fifteenth floor, where I attended three births and stood behind a gowned team of doctors. I was a spectator, the mirror girl holding a large oval mirror to show the patient her baby emerging into the world through her legs.

Almost two years later, I returned to the same delivery rooms. I am currently on my OB-GYN rotation. And for my first week, I have solely worked nights, from 6 PM to 8 AM. Surviving these unnatural hours has required a large cup of coffee and many cups that follow during the night.

In many ways, things have changed. This time around, I am standing in an entirely different place with a completely different job. While I have grown in my role, some things have not changed; I continue to marvel at birth and the views of SF from the 15th floor.

My patients room was in the East corner. The glittering lights of downtown skyline were visible through the darkness. The room lights had been dimmed. Her bed was close to the window right next to a pull out sofa. The infant exam area was nestled in the opposite corner of the large room.

When I met my patient for the first time, a woman in her late twenties, she was lying in her bed wearing a hospital gown. Her black hair was pulled back and beads of sweat were forming on her light skin. She had gray eyes. And the only clue to knowing she was pregnant was her gravid abdomen. She was well-trimmed, the result of weekly sessions with a personal trainer. Her toenails had been painted a nice shiny silver. She breathed through the contractions and spoke through the contractions.

She was joined by her husband, who was by her side the whole time, holding her hand. He was in his late twenties. He had brown hair and dark blue eyes. He looked like the poster child of fitness; he was thin with a build of a runner.

"We are hoping, the baby will have a mix of my blue eyes and her gray eyes. And maybe a touch of my brown hair." he said.

This was their first baby and he was arriving close to his scheduled estimated date of delivery. She started having contractions at 3 AM of the previous day. When she arrived to our triage room, she was examined, after which her water broke. She was placed in a delivery room because she was in active labor and had been laboring all day.

During my shift, I coached her through the last five hours of her labor. With the guidance of a seasoned labor nurse, we encouraged our patient to take deep breaths and then push. Breath and then push. Over and over again. This became our mantra. And slowly, the baby made it's way down.

In between the painful pushing; she would briefly pause and take a deep breath. Through the entire process she requested on only one thing.

"Can I have some ice chips?" She would ask.

She had decided to have a natural delivery, so there were no epidural or pain medications. There was no IV sticking out of her arm. She was able to move out of her bed and change positions as needed to help position herself more comfortably, which became incredibly difficult. As the labor progressed, the deeps breaths turned into grunts and screams as each contraction became even more painful and intense.

With no pain medication, we could only offer encouragement, guidance, and ice chips (by the end she had gone through three large cups of ice chips). And that's what we did. And slowly, she was able to push harder and harder, until we started to see the black hairs on the baby's head.

"Babe, I can see his hair. He's almost here." Her husband said minutes before we went on to deliver the baby.

The delivery itself represented a small fraction of the entire of laboring process. It was the climax of an entire day of contractions and pushing. Once the head started to crown, we prepared to deliver the baby. So much seemed to happen in the those minutes. The instrument tray was uncovered and we quickly put on our masks, gowns, and gloves. The lights were turned on. We were joined by the other doctors. With my hands and some assistance, I guided the baby's head, while protecting the mother's perineum.

Inch by inch, and with each push and contraction, more and more of the head could be seen. Between pushes, the head would pop back in, almost like playing peek-a-boo. Eventually, we were able to safely guide the head, followed by the shoulders and then the rest of the body out. Before I knew it, he was in my arms, covered in blood and fluid. He was also very slippery and warm (as I had been warned).

There was a sudden calm, as we rejoiced in the end of the delivery and waited to hear the baby to introduce himself with a loud cry.

For a second he was a silent, but within seconds, he started to cry. His color transformed from a ashen blue to a dark pink. We clamped his cord and dad cut the cord between our two metallic instruments. I handed the baby to the pediatrician, who was standing behind me with an open blanket in her arms. After he was evaluated, he was returned to mom and dad.

We went on to deliver the placenta by applying supra pubic pressure and applying traction of the cord. Once the floppy structure fell into the bucket, we worked on repairing the laceration that comes from having a baby pass through a vagina.

The whole process of birth, from labor to delivery, is simply magical. At times, it can be difficult to watch as you see the mother experiencing such intense pain with each contraction. At the same time, you are simply amazed by the instantaneous change that happens with the birth of a baby. You see the whole spectrum of human emotion, everything from pain to anger to anxiety to joy to happiness all in the course of delivery.

In many ways, it's transformative process for the people involved. In one day, many lives change. The nine months of waiting and wondering and worrying culminate with a new addition to a family; parents are sloe born.

In my small role, I helped my patient and her husband transition to the next phase in their lives--parenthood. For me, it was more than just catching a baby; it was one of the most memorable experiences of medical school, one of the greatest gifts anyone could have given me. I feel so lucky to have delivered their baby; to have held their baby for the first time. I feel so humbled and thankful for this catch.